Safe disposal of contaminated medical objects has become of utmost concern, especially to the medical community. Accidental needlesticks with contaminated needles account for one of the most serious health risks for medical personnel because of bloodborne pathogens such as AIDS and hepatitis. The magnitude of this sometimes deadly problem may be partly appreciated by the U.S. Government's report in the Federal Register of May 30, 1989 of over 600,000 annual accidental needlesticks.
Medical practitioners are most vulnerable to a needlestick at two critical times during patient care activities: immediately upon the withdrawal of a contaminated needle from a patient and during post-procedure clean-up after the activity is concluded. Almost invariably when a needle is withdrawn the practitioner's attention is divided between needle/syringe disposal and continued patient care. For example, often stabilization and/or pressure must be applied at the site of the intravenous insertion or intramuscular injection, leaving the practitioner tethered to the patient with only one hand free to dispose of the needle/syringe. Frequently the contaminated needle/syringe is simply laid down within the reach of the practitioner's arm. During post-procedure clean-up, at which time the contaminated needle/syringe must be handled a second time, the precise temporary position and orientation may be forgotten or the needle/syringe moved by another, and its position rediscovered by a needlestick.
Vigorous efforts have been made to develop needles and syringes, and disposal devices therefor that are commonly referred to as "sharps" containers or collectors, that reduce the incidence of accidental needlesticks. Such devices may be classified in one of three major categories: needle and syringe containment, needle and syringe destruction, and needle recapping.
Sharps collectors, such as model 5400 series commercially available from Becton Dickinson and Company of Rutherford, N.J., are free-standing or wall-mounted containers that include a "valved" opening to receive the contaminated needle and syringe, a slot to assist in the hands-free removal of the needle from the syringe, and a closure cap. Other sharps containers, such as that described in U.S. Pat. No. 4,969,554, contain a non-valved opening, but include a block of foam to receive and hold the needle. Unfortunately, sharps collectors are very often outside easy arms reach of the practitioner at the time of needle removal, encouraging the temporary needle/syringe placement described above. Even when within reach, the opening may be missed if the practitioner's concentration and visual attention are not directed toward the sharps container. Moreover, under some circumstances free-standing units may require both hands for safe disposal. Also, larger box- or cylindrical-shaped sharps containers invite overfilling and non-uniform orientation of sharp medical objects, resulting in many needlestick injuries.
Needle and syringe destruction devices, such as the Model 8600 commercially available from Becton Dickinson and Company of Rutherford, N.J., cut off the needle near the syringe hub and may optionally cut off the luer adapter from the syringe barrel. These devices require two-hand operation, the practitioner's undivided concentration and attention and, depending on the particular configuration, manual placement of the pieces in suitable sharps collectors or other appropriate medical refuse containers. Furthermore, residual fluids in the syringe or needle have been known to frequently splatter the practitioner when cut.
Another class of devices allow the recapping of needles. Typical of one type of recapping device are the Monoject Safety Syringe with Safety Shield and Needle commercially available from Sherwood Medical of St. Louis, Mo. (shown in U.S. Pat. No. 4,743,233), and the Protectiv I.V. Catheter commercially available from Critikon, Inc. of Tampa, Florida. This first type of device includes a needle cover or shield which is mounted coaxial with the syringe. After use the cover is slid by finger pressure over the syringe needle until an audible click is heard to confirm its locking. During emergency conditions it is very often not possible to hear or feel the interlock engagement click, resulting in cover retraction as soon as one's finger is removed.
Another type of needle recapping device is seen in the ON.GARD Recapper commercially available from ON.CARD Systems, Inc. of Denver, Colo. This is a hand-held unit with a cylindrical grip in which a needle cap is held by a pressure-actuated mechanism. A substantially planer, rectangular plate attached to one end of the grip protects the hand holding the grip while the needle is reinserted into its cap. Here again, successful use of this device requires the practitioner's undivided concentration and attention and works best when done with two hands.